runner ball of foot pain

by kristin c
(oregon)

I'm 29 years old and have always been very active. I currently run 4 miles a day and work 12 hr shifts in the ER. About 4 weeks ago I was sick for 4 days and didn't run. I hit it " hard " after I was better; and ran 4 miles at a quick pace with interval sprints. At mile 3.5, I noticed an aching sensation in the ball of my left foot. I took off my shoes and couldn't put weight on it for about 2 minutes. Then the pain went away and I could walk normally barefoot. That evening thtop of my foot began to swell and I had pain in the bottom again. I placed ice on the ball of my foot which made it ache worse while icing but pain was better after. The next day there was bruising and swelling on top of my foot, but no pain when barefoot. At work the ball of my foot began to ache but no tingling into toes. The pain continued to come and go throughout the day. The worst it got was when I was squatting at bedside (on the ball of foot) and when I stood up there was an intense aching/ burning sensation. I continued to run on it with some padding on ball of foot which helped. Pain continues to he worse at end of run, especially if I flex or extend toes afterwards it will burn badly. And it improves with rest.

I admit I wear arch supports in both shoes because I didn't want to wear them for just my right flat foot even though my left foot was getting blisters in the arch ( I was afraid my hips would be uneven).
History:
I dropped 50 lb weight ten years ago on my left foot but never got X-Ray because didn't want to miss basketball (over navicular area)
Multiple sprains 10 years ago left ankle
Tripped 2 times this past year on my left foot doing sprints
I have been running on old shoes and the same arch support for a year

Current: less running and pain is only there if I press on my 3rd metatarsal joint on the pad. Running continues to make worse. I haven't seen doctor 2nd to expensive insurance and I feel I can treat at home

Question: I don't care about the pain as much as I am worried that I am worsening my condition. I would like to continue running with some padding and correct arch supports, New shoes, anti-inflammatories etc. Unless you think it's imperative I rest and do other activities


RESPONSE

Hi Kristin,

Because your original pain started during a run and ended up hurting both on the top and bottom of the foot, you need to have an x-ray to rule out a stress fracture. In theory, a stress fracture should hurt all the time, perhaps in varying degrees, which it sounds like your foot does not, but it still needs to be x-rayed.

If you do have a stress fracture, it needs to be dealt with as otherwise the foot may not heal properly and you will be left with residual ongoing pain. Things like rest, anit-inflammatories, arch supports will not make the foot better.

Having said that, based on your narrative, it sounds like you may have a capsulitis, which you can read about on this site. You note that when you were bending down at bedside you really felt the pain which happens in capsulitis when the toes are bent upwards.

If your x-ray is negative for fracture, then you might go with a working diagnosis of capsulitis, although you would be much better off having the foot examined by a doctor to get an accurate diagnosis.

An orthotic with a built in metatarsal pad can be very effective in treating this problem. (if you think this is your problem, you could consider ordering a running orthotic with a metatarsal pad on this site).

Additionally, if you are a serious runner you cannot be running around in old broken down running shoes. Possibly, the biggest cause of foot and ankle problems that I see in runners is from running shoes that should have been replaced months earlier.

Particularly in capsulitis, if there is too much bend in the shoe at the level of the ball of the foot, this causes the toes to over stretch and of course over stretching can cause capsulitis.

A new pair of running shoes will certainly be more rigid in the forefoot and additionally will offer better shock absorption and foot control in your running cycle.

If you have a stress fracture or capsulitis, just resting the foot, along with oral medication may not be enough to make you better

Marc Mitnick DPM
DISCLAIMER